The effect of non-steroidal anti-inflammatory drugs on severity of acute pancreatitis and pancreatic necrosis

Ann R Coll Surg Engl. 2018 Mar;100(3):199-202. doi: 10.1308/rcsann.2017.0205. Epub 2017 Nov 28.

Abstract

Introduction Acute pancreatitis (AP) is a common emergency presentation and can be disabling. There is significant morbidity and mortality associated with AP, and it places a considerable burden on the healthcare system. Non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to have a protective effect in some elective contexts. This retrospective study aimed to evaluate the effect of NSAIDs on the course of AP and the severity of the disease. Methods A retrospective analysis was carried out of 324 patients admitted as an emergency with a diagnosis of AP to two UK hospitals. Patients were divided into two groups: those already taking NSAIDs for other co-morbidities and those not taking NSAIDs. Variables compared included: admission to a high dependency or intensive care unit; pancreatic necrosis; pseudocyst development; need for surgery; serum inflammatory markers; modified early warning scores on days 1, 3 and 5; length of stay; and mortality. Results Patients not taking NSAIDs were more likely to have a C-reactive protein level of ≥150mg/l (p=0.007). Patients in the NSAID group experienced less pancreatic necrosis (p=0.019) and lower rates of pseudocyst formation (p=0.010). Other variables showed no difference between the two groups, specifically length of stay and mortality. Conclusions Routine NSAID use may exert a protective effect on the development of AP, its severity, and complications. Therapeutic use of NSAIDs in acute presentations with pancreatitis should be further evaluated.

Keywords: Acute pancreatitis; Non-steroidal anti-inflammatory drugs.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Disease Progression
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pancreatitis / diagnosis
  • Pancreatitis / drug therapy*
  • Pancreatitis / mortality
  • Pancreatitis / prevention & control*
  • Pancreatitis, Acute Necrotizing / diagnosis
  • Pancreatitis, Acute Necrotizing / drug therapy
  • Pancreatitis, Acute Necrotizing / mortality
  • Pancreatitis, Acute Necrotizing / prevention & control
  • Protective Factors
  • Retrospective Studies
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents, Non-Steroidal